EAST TEXAS BORDER HEALTH CLINIC (GENESIS PRIMECARE) - NPI NUMBER 1700134996
Provider Name: EAST TEXAS BORDER HEALTH CLINIC (GENESIS PRIMECARE)
NPI Number: 1700134996
Clasification: General Practice (208D00000X)
502 E RUSK ST
Phone Number: (903) 927-3782
EAST TEXAS BORDER HEALTH CLINIC is a general practitioner in Marshall, TX. The assigned NPI number for this provider is 1700134996 and is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Genesis Primecare.
The provider's business address is:
502 E RUSK ST
Phone: (903) 927-3782
Fax: (903) 927-1764
The provider's authorized official is David L Hartman .
The authorized official title is Ceo and has the following contact phone number (903) 927-3782.
The enumeration date for this NPI number is 8/21/2012 and was last updated on 8/21/2012.
Map - Location of Practice
The following information regarding the scope of practice of this provider is available:
||Entity Type Code
||Employer Identification Number EIN
||Provider Organization Name Legal Business Name
||EAST TEXAS BORDER HEALTH CLINIC
||Provider Other Organization Name
||Provider Other Organization Name Type Code
||Provider First Line Business Practice Location Address
||502 E RUSK ST
||Provider Business Practice Location Address City Name
||Provider Business Practice Location Address State Name
||Provider Business Practice Location Address Postal Code
||Provider Business Practice Location Address Country Code If outside U S
||Provider Business Practice Location Address Telephone Number
||Provider Business Practice Location Address Fax Number
||Provider Enumeration Date
||Last Update Date
||Authorized Official Last Name
||Authorized Official First Name
||Authorized Official Middle Name
||Authorized Official Title or Position
||Authorized Official Telephone Number
||Healthcare Provider Taxonomy Code 1
||Healthcare Provider Primary Taxonomy Switch 1
||Is Organization Subpart
||Authorized Official Name Suffix Text
||Healthcare Provider Taxonomy Group 1
||193200000X MULTI-SPECIALTY GROUP
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This page was last updated on: 1/13/2015
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